Ayushman Bharat PM-JAY Tripura

How PM-JAY Works in Tripura

The PM-JAY Scheme in Tripura is administered by the State Health Agency (SHA), Health & Family Welfare Department, Government of Tripura. The scheme is integrated with the state-run health insurance scheme known as Mukhyamantri Jan Arogya Yojana (CM-JAY) so as to include those who do not come under AB-PMJAY.

State Health Agency (SHA) administers AB-PMJAY and CM-JAY schemes on a day-to-day basis in Tripura. SHA empanels and constantly monitors the quality of healthcare institutions, both in the public and private sectors, in order to maintain standards in healthcare for the patients. SHA manages the entire process of pre-authorisation and claims settlement process through central online portals, thus providing quick, cashless and paperless medical treatment in the hospitals.

Key Highlights: PM- JAY Tripura

Who is Eligible to Apply for PM-JAY Tripura

• SECC 2011 Database: Families falling into socio-economically vulnerable groups identified through the Socio-Economic Caste Census (SECC 2011) database in both rural and urban areas of Tripura.
• Rural Area: Family residing in kutcha houses, family without adult male members and headed by females, landless casual labour family, SC/ST family, and so forth.
• Urban Area: Specific occupations such as ragpickers, domestic workers, street vendors, construction workers, drivers, transport workers, sanitation workers, and mechanics.
• RSBY Cardholder: Beneficiaries in the existing Rashtriya Swasthya Bima Yojana (RSBY) scheme.
• BoCW Construction Workers: Registered construction labourers under the Tripura Building and Other Construction Workers Welfare Board.
• PVTG Families: Particularly Vulnerable Tribal Group under the PM-JANMAN scheme.

Benefits and Coverage under PM-JAY Tripura

• Financial Coverage: The scheme provides a health coverage of up to ₹5 lakh per family per year on a family floater basis for secondary and tertiary care hospitalisation.
• Zero Co-pay Limit: This insurance policy covers all costs incurred during hospitalisation and pre- and post-care, including the cost of hospital bed/ICU, surgeons' and consultants' fees, diagnostics, blood, oxygen and surgical implants.
• Cashless & Paperless Services: Beneficiaries can access care directly at empanelled hospitals without upfront cash payments or out-of-pocket expenses.
• Pre-hospitalisation Cover: This policy provides coverage for all clinical and consultation costs up to 3 days prior to hospital admission.
• Post-hospitalisation Cover: Provides cover for follow-up consultation and diagnostics, along with free medicines up to 15 days after discharge from the hospital.
• Pre-existing Diseases Covered: All preexisting diseases are immediately covered without any waiting period from Day 1.
• No cap on Family Size and Age: No one (especially women, children and other elderly family members) is left uncovered.

1,949 Standardised Treatment Packages: It includes secondary & complex tertiary procedures like:

• Cardiology and Cardiothoracic surgery (like Angioplasty, CABG), Oncology (Radiation, Chemotherapy, Surgical oncology)
• Orthopaedic Procedures (Like joint replacements, complex fracture fixations), Nephrology & Dialysis, Neurosurgery & Pediatrics

How to Apply Step by Step for PM-JAY Tripura

Step 1: Go to the PM-JAY Tripura Portal/App

Open the official NHA Beneficiary Portal (beneficiary.nha.gov.in) using your browser or download the official Ayushman App from your Smartphone.

Step 2: Login & Select Your State as Tripura

Click on the Beneficiary Mode and enter your 10-digit mobile number. Enter the OTP (One Time Password) received on your mobile phone. Select the state as Tripura, select the Scheme as PM-JAY, and then write the captcha to log in.

Step 3: Search for Your Family or Household Information

• Search for your family information using your Family ID (Tripura Ration Card ID), Aadhaar Number or District/Village Location.
• Click on the Search button to see all matching family members in your household.

Step 4: Verify Your e-KYC Data

Find your name from the search result and click on "e-KYC". Select your method of authentication - Aadhaar OTP (sent to your mobile number linked with your Aadhaar ID), Facial Recognition or Iris Scanning.

Step 5: Approval & Download of Ayushman Card

• When your e-KYC information matches successfully with the state database, your status will be "Approved" (or "Pending" until the State Health Agency Tripura verifies your record). Once you receive the "green Approved" tag:
• Click on the Download icon to download your Ayushman Card.

Documents Required for PM-JAY Tripura

• Aadhaar Card: Mandatory for every individual family member for biometric, Iris, or OTP based e-KYC.
• Active Mobile No: Should be linked to Aadhaar Card to receive OTP while logging in, authentication, and download of card.
• Smart Ration Card/Tripura NFSA Ration Card: Acts as the main document of the Family ID for verifying the family's eligibility according to the SECC database/State of Tripura.
• PM-JAY Family ID or Household ID Letter: Official Letter/HHID issued by the State Health Agency (SHA), Tripura, for eligibility verification.
• Tripura Permanent Resident Certificate (PRTC)/Domicile Proof: Necessary mainly for state-level beneficiary verification of

How to Avail Cashless Treatment in Tripura

No payment is required in advance, nor is any form of claim reimbursement. Here are the steps to follow while visiting a hospital:

• Visiting the Hospital: Visit the emergency ward or OPD in any empanelled PM-JAY hospital in Tripura.
• Meet Ayushman Mitra: Find the dedicated Ayushman Mitra Helpdesk near the reception area.
• Show Your Ayushman Card: Submit your Ayushman Card (PM-JAY Card ) and Aadhaar Card to the Ayushman Mitra.
• Verification and Patient Registration: Biometric verification (Fingerprint/iris scan) or OTP will be sent to your mobile for verifying you. Then, an e-token/case file will be created for your admission.
• Undergoing treatment (100% Cashless): Tests, medicines, and operations will be prescribed by the doctor.
• All-inclusive: Fees of doctor, pre-hospitalisation tests, medicines, ICU/room cost, surgeries, and post-discharge medicines.

Helpline and Support

Other Government Schemes

• Chief Minister Jan Arogya Yojana (CM-JAY): Tripura residents not covered under central PM-JAY or other government health insurance schemes can apply for CM-JAY to receive identical ₹5 Lakh/year cashless coverage at empanelled hospitals.
• Ayushman Vay Vandana Card: The scheme for all senior citizens aged 70 or above is entitled to a dedicated Vay Vandana card offering up to ₹5 Lakh/year in coverage, regardless of family income or existing eligibility status.
• Tripura Journalist Insurance Scheme: a state health insurance scheme that offers medical coverage to working media professionals.
• Central Government Health Scheme: Central scheme that offers Health Insurance coverage to government employees, their dependents and retirees.
• Ayushman Bharat: a centrally sponsored Health Insurance scheme that offers coverage of up to ₹5 Lakh/year for poor and Vulnerable families.